Related Experiment Video
Updated: Apr 22, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Predictors of perioperative complications in higher risk children after adenotonsillectomy for obstructive sleep
Anchana Thongyam1, Carole L Marcus2, Justin L Lockman3
1Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA Bangkok Pattaya Hospital, Chonburi, Thailand Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Polysomnography (PSG) can predict respiratory complications after adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Younger age and Black race are risk factors, but current guidelines have limitations for predicting postoperative outcomes.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Anesthesiology
Background:
- Adenotonsillectomy is a common procedure for pediatric obstructive sleep apnea syndrome (OSAS).
- Predicting perioperative risk in this population is challenging, with limited data from prospective studies.
- Existing retrospective studies have shown limitations in accurately assessing perioperative risks.
Purpose of the Study:
- To investigate the predictive value of demographic and polysomnographic (PSG) variables for perioperative complications following adenotonsillectomy in children with OSAS.
- To identify specific PSG parameters and demographic factors associated with respiratory and non-respiratory complications.
- To evaluate the efficacy of current clinical guidelines in predicting these complications.
Main Methods:
- Prospective, observational cohort study conducted at a pediatric tertiary center.
- Inclusion of consecutive children undergoing adenotonsillectomy for OSAS within 12 months of PSG.
- Evaluation of complications occurring within two weeks of surgery.
Main Results:
- Out of 329 subjects, 28% experienced respiratory complications and 33% had non-respiratory complications.
- Significant associations were found between PSG parameters (apnea-hypopnea index, SpO2 nadir, peak end-tidal CO2) and respiratory complications.
- Age under 3 years and Black race were also associated with increased respiratory complication risk. PSG did not predict non-respiratory complications.
Conclusions:
- Polysomnography (PSG) effectively predicts perioperative respiratory complications in children with OSAS undergoing adenotonsillectomy.
- Younger age (<3 years) and Black race are identified as significant risk factors for respiratory complications.
- Current guidelines for predicting postoperative admission need improvement as they are limited in this high-risk pediatric population.
Objective:
Retrospective studies have limitations in predicting perioperative risk following adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Few prospective studies exist. We hypothesized that demographic and polysomnographic (PSG) variables would predict respiratory and general perioperative complications.
Study Design:
Prospective, observational cohort study.
Setting:
Pediatric tertiary center.
Subjects And Methods:
Consecutive children undergoing adenotonsillectomy for OSAS within 12 months of PSG were evaluated for complications occurring within 2 weeks of surgery.
Results:
There were 329 subjects, with 27% <3 years old, 24% obese, 16% preterm, and 29% with comorbidities. In this higher risk population, 28% had respiratory complications (major and/or minor), and 33% had nonrespiratory complications. Significant associations were found between PSG parameters and respiratory complications as follows: apnea hypopnea index (rank-biserial correlation coefficient [r] = 0.174, P = .017), SpO2 nadir (r = -0.332, P < .0005), sleep time with SpO2 <90% (r = 0.298, P < .0005), peak end-tidal CO2 (r = 0.354, P < .0005), and sleep time with end-tidal CO2 >50 mm Hg (r = 0.199, P = .006). Associations were also found between respiratory complications and age <3 years (r = -0.174, P = .003) or black race (r = 0.123, P = .039). No significant associations existed between PSG parameters and nonrespiratory complications. A model using age <3 years, SpO2 nadir, and peak CO2 predicted respiratory complications better than the American Academy of Pediatrics or American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines but was imperfect (area under the curve = 0.72).
Conclusion:
Thus, PSG predicted perioperative respiratory, but not nonrespiratory, complications in children with OSAS. Age <3 years or black race are high-risk factors. Present guidelines have limitations in determining the need for postoperative admission.
